Fat embolism syndrome with neurological involvement: A case report

BACKGROUND: Fat Embolism Syndrome (FES) occurs when the contents (or some component of) the bone marrow is released into the circulation, generally as the result of long bone fracture. It poses significant challenges in both diagnosis and treatment and, as such, is primarily a diagnosis of exclusion with no definitive treatment. We present a case where heightened awareness of the clinical team allowed for early identification and immediate initiation of supportive care, nitric oxide (NO) for potential mitigation of right heart failure, and pharmacological treatment with atorvastatin. PATIENT: A 16-year-old male with multi-system trauma, including bilateral long-bone fractures, developed Fat Embolism Syndrome with neurological and respiratory symptoms within 24 h of admission. RESULTS: Within 24 h of initiation of high dose atorvastatin and inhaled Nitric Oxide our patient showed signs of improvement, including decreasing oxygen requirement's and normalization of mental status. CONCLUSION: We postulate that the combined therapy of high-dose atorvastatin with Nitric Oxide may have played a role in our patients' full recovery in a shortened timeframe. Ideally, further prospective research is needed to determine a universally accepted treatment regimen for pediatric patients with FES.